Provider Demographics
NPI:1528632197
Name:CARTER, DEBORAH (LSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E JACKSON BLVD STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-4184
Mailing Address - Country:US
Mailing Address - Phone:312-663-1300
Mailing Address - Fax:312-663-0504
Practice Address - Street 1:2323 STEVENSON DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-4331
Practice Address - Country:US
Practice Address - Phone:877-381-6538
Practice Address - Fax:217-529-9151
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150009411104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker